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Adrenal insufficiency, Cushing's disease, growth hormone, fatty liver, cortisol
Abstract:
Non-alcoholic fatty liver disease (NAFLD) is a hallmark of the metabolic
syndrome and has been shown to be an independent predictor of
cardiovascular mortality. Although glucocorticoids and growth hormone
are known to be implicated in its pathophysiology, it has only rarely
been investigated in the context of patients with pituitary
insufficiency or former cortisol excess.
Case-control study in patients with biochemically controlled Cushing's
disease (CD; N = 33) and non-functioning pituitary adenomas (NFPA; N =
79). NAFLD was estimated by calculating the fatty liver index (FLI)
including BMI, waist circumference, GGT and triglyceride levels.
Although there was no difference in FLI between patients with NFPA and
CD, we identified average daily hydrocortisone (HC) intake in those with
adrenal insufficiency to be an independent predictor of FLI (beta =
1.124; p = 0.017), even after adjusting for BMI and waist circumference.
In line, those with a FLI > 60 were also taking in average significantly
more HC per day than those with a score < 60 (21.05 mg +/- 5.9 vs. 17.9
mg +/- 4.4; p = 0.01). FLI was also the best independent predictor for
HbA1c and fasting glucose levels (both p = 0.001). Growth hormone
deficiency and replacement therapy were not associated with FLI in
either group.
While HC dosage affects FLI as an estimate of NFLD in patients with CD
and NFPA, the benefit of GH replacement still needs to be determined. In
contrast to reports in CD patients with active disease, NAFLD in those
with biochemical control was not different from NFPA patients.
